MEDICARE: LIMA MEMORIAL PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1457474900	OTHER	OH	GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114978244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIMA MEMORIAL PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1001 BELLEFONTAINE AVE
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-2800
Country	:	US
Telephone Number	:	419-998-4575
Fax Number	:	419-998-4586

Provider Business Practice Location Address
First Line	:	1005 BELLEFONTAINE AVE STE 345
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-2886
Country	:	US
Telephone Number	:	419-229-3362
Fax Number	:	419-229-8258

Authorized Official
Title or Position	:	DIRECTOR OF LMP
Name	:	JEFFREY UTZ
Credential	:
Telephone Number	:	419-998-4668

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	02/11/2026

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Directions to “LIMA MEMORIAL PROFESSIONAL CORPORATION ” Practice Location

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